The interim aged care royal commission report makes clear that a dramatic increase in funding is going to be needed to give Australia an aged care system that doesn’t make us ashamed. But it’s also clear such an increase isn’t going to be enough. The aged care crisis — and nothing short of that term is sufficient — is a frighteningly complex policy problem and one that’s not going to be fixed quickly.

If you haven’t read the foreword to the commission’s interim report, go and do so right now. It’s harrowing and shameful. It’s unsurprising the government was taken aback by the scale of neglect, abuse and mistreatment that is being meted out to elderly Australians, and the blunt language the report — bearing the imprint of the late Richard Tracey — uses to convey it.

Nor does the report shy from noting (as Joseph Ibrahim points out) that so many of these problems are well known and yet have been allowed to continue. The only appropriate response is deep anger at a problem that is in no way new.

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Left isolated and powerless in this hidden-from-view system are older people and their families. ‘This is not a life.’ ‘This is not my home.’ ‘Don’t let this happen to anyone else.’ ‘Left in her own faeces, and still no one came.’ ‘Mum doesn’t feel safe.’ This cruel and harmful system must be changed. We owe it to our parents, our grandparents, our partners, our friends. We owe it to strangers. We owe it to future generations. Older people deserve so much more.

It’s clear that a dramatic expansion in funding for home care packages is urgently needed, and will most likely be announced by the government next month: the push to increase funding to enable Australians to age in their homes rather than move into residential care is more than a decade old and home care funding has increased more than 40% since 2013, but with senior Australians waiting more than a year for the highest level of care packages, it is manifestly not enough.

In fact funding across the entire sector has significantly increased, despite the government cracking down on the rorting of the Aged Care Funding Instrument: in the last five years, Commonwealth funding on all aged care has grown around 43%, and yet the sector is still a national scandal. Worse, as this year’s annual report on aged care funding shows, the financial performance of both residential and home care providers suffered a “sizeable” decline in 2017-18 (likely as a result of the government ACFI crackdown).

The problem with pumping more urgently needed money into the sector is where the workforce will come from. More than a quarter of a million people currently work in residential care facilities, and their numbers grew 26% in the five years to August — one of the fastest growing subsectors in the entire economy, faster even than the broader health and social care sector. Similar growth over the next five years will require another seventy thousand aged care workers. Longer-term, that will accelerate, given aged care funding is forecast to nearly double to 1.7% of GDP in the 2050s.

There’s now an Aged Care Workforce Industry Council that is supposed to oversee the implementation of an Aged Care Workforce Strategy, but that only set up shop a few months ago. The workforce relies more heavily on migrant workers than other industries, with 37% of workers born overseas (including around 50% of personal care assistants) and the government recently introduced looser visa requirements for the aged care sector. Improved quality of care in residential aged care will likely require a significant expansion of a heavily migrant workforce.

The problem for a rapid growth of home care packages is that it will attract rorters and criminals. The experience of sectors that have seen the expansion of government funding, such as childcare, vocational education and the NDIS, is that crooks have been lured in by the prospect of large increases in funding in a sector without the capacity to immediately use it, creating opportunities for unscrupulous “service providers”. Rorters have migrated from childcare to disability services as regulators have cracked down or consumers have wised up, and there’s no reason to think an expansion of home care won’t see the same migration — indeed, there are already horror stories of elderly people being fleeced by home care providers. The home care sector also faces allegations of widespread tax dodging.

Pumping hundreds of millions of dollars of additional funding into home care — while crucial — is likely to also see more rorts and rip-offs, particularly given the “customers” and “clients” are vulnerable older Australians. This isn’t an easy problem to fix. And it will take a long time.

Are we seeing the beginning of change in a broken industry? Will the royal commission really make a difference? Let us know your thoughts at boss@crikey.com.au. Please include your full name if you would like to be considered for publication. 

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Peter Fray
Peter Fray
Editor-in-chief
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